St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

HC CT SCAN OF ARM CONTRAST - CT ELBOW W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320102
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT ELBOW W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320102
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT HAND W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320101
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT HAND W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320101
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320105
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT RADIUS ULNA W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320105
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT SHOULDER ARTHROGRAM W FL GUIDED INJ

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320110
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT SHOULDER ARTHROGRAM W FL GUIDED INJ

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320110
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT SHOULDER W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320103
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT SHOULDER W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320103
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320112
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT UPPER EXTREMITY W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320112
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF ARM CONTRAST - CT WRIST W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320107
Hospital Revenue Code	352
Min. Negotiated Rate	$155.87
Max. Negotiated Rate	$867.00
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$635.80
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$171.77
Rate for Payer: Aetna Government	$171.77
Rate for Payer: Brighton Health Commercial	$867.00
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$155.87
Rate for Payer: Group Health Inc Commercial	$578.00
Rate for Payer: Group Health Inc Medicare	$404.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00
Rate for Payer: Hamaspik Choice Inc Medicare	$578.00
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$155.87
Rate for Payer: Healthfirst Essential Plan	$436.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$194.03

HC CT SCAN OF ARM CONTRAST - CT WRIST W IV CONTRAST

Facility

$1,156.00

Service Code	CPT 73201 TC
Hospital Charge Code	3527320107
Hospital Revenue Code	352
Min. Negotiated Rate	$578.00
Max. Negotiated Rate	$578.00
Rate for Payer: Hamaspik Choice Inc Medicaid	$578.00

HC CT SCAN OF LEG COMBO - CT FEMUR W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370201
Hospital Revenue Code	352
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.13
Rate for Payer: Aetna Government	$223.13
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$148.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.54
Rate for Payer: Healthfirst Essential Plan	$698.53
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.46

HC CT SCAN OF LEG COMBO - CT FEMUR W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370201
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT SCAN OF LEG COMBO - CT HIP W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370209
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT SCAN OF LEG COMBO - CT HIP W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370209
Hospital Revenue Code	352
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.13
Rate for Payer: Aetna Government	$223.13
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$148.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.54
Rate for Payer: Healthfirst Essential Plan	$698.53
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.46

HC CT SCAN OF LEG COMBO - CT KNEE W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370206
Hospital Revenue Code	352
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.13
Rate for Payer: Aetna Government	$223.13
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$148.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.54
Rate for Payer: Healthfirst Essential Plan	$698.53
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.46

HC CT SCAN OF LEG COMBO - CT KNEE W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370206
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT SCAN OF LEG COMBO - CT LOWER EXTREMITY W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370204
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT SCAN OF LEG COMBO - CT LOWER EXTREMITY W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370204
Hospital Revenue Code	352
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.13
Rate for Payer: Aetna Government	$223.13
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$148.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.54
Rate for Payer: Healthfirst Essential Plan	$698.53
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.46

HC CT SCAN OF LEG COMBO - CT TIBIA FIBULA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370202
Hospital Revenue Code	352
Min. Negotiated Rate	$275.50
Max. Negotiated Rate	$275.50
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50

HC CT SCAN OF LEG COMBO - CT TIBIA FIBULA W AND WO IV CONTRAST

Facility

$551.00

Service Code	CPT 73702 TC
Hospital Charge Code	3527370202
Hospital Revenue Code	352
Min. Negotiated Rate	$148.54
Max. Negotiated Rate	$715.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$223.13
Rate for Payer: Aetna Government	$223.13
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$715.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$602.07
Rate for Payer: EmblemHealth Commercial	$148.54
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$148.54
Rate for Payer: Healthfirst Essential Plan	$698.53
Rate for Payer: United Healthcare Commercial	$267.39
Rate for Payer: Wellcare CHP/FHP/Medicaid	$310.46

HC CT SCAN OF LEG CONTRAST - CT ANKLE W IV CONTRAST

Facility

$551.00

Service Code	CPT 73701 TC
Hospital Charge Code	3527370112
Hospital Revenue Code	352
Min. Negotiated Rate	$120.59
Max. Negotiated Rate	$641.58
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$303.05
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$175.12
Rate for Payer: Aetna Government	$175.12
Rate for Payer: Brighton Health Commercial	$413.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$641.58
Rate for Payer: Cigna LocalPlus Benefit Plan	$540.04
Rate for Payer: EmblemHealth Commercial	$120.59
Rate for Payer: Group Health Inc Commercial	$275.50
Rate for Payer: Group Health Inc Medicare	$192.85
Rate for Payer: Hamaspik Choice Inc Medicaid	$275.50
Rate for Payer: Hamaspik Choice Inc Medicare	$275.50
Rate for Payer: Healthfirst CHP/FHP/Medicaid	$120.59
Rate for Payer: Healthfirst Essential Plan	$440.57
Rate for Payer: United Healthcare Commercial	$239.85
Rate for Payer: Wellcare CHP/FHP/Medicaid	$195.81

Know your out-of-pocket cost for care.

All Charges